Meibomian Gland Dysfunction in Primary and Secondary Sjögren Syndrome

Sullivan, David A.; Dana, Reza; Sullivan, Rose M.; Krenzer, Kathleen L.; Şahin, Afsun; Arica, Beril; Liu, Yang; Kam, Wendy R.; Papas, Athena; Cermák, J

doi:10.1159/000487487

Cited by 54 publications

(36 citation statements)

References 80 publications

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“…Sjögren syndrome (SS) is one of the leading causes of dry eye, and several recent studies report that MGD may play an essential role in SS 33–35. SS patients were reported to have significantly more MG loss than both non-SS dry eyes and controls 34.…”

Section: Discussionmentioning

confidence: 99%

The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases

Robin

Liang

Rabut

et al. 2019

Trans. Vis. Sci. Tech.

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Purpose: To evaluate dysfunction in various ocular surface diseases (OSDs) including primary meibomian gland disease (MGD), perennial allergic conjunctivitis, and primary and secondary Sjögren syndromes. Methods: A retrospective analysis of 146 patients (111 women and 35 men) with symptomatic OSDs was performed. Patients were divided into two groups: the non-MGD group (55 patients) and the MGD group (91 patients). All patients had an evaluation of ocular surface symptoms and clinical tests, including tear film breakup time (BUT), the first and the mean noninvasive breakup time (NIKBUTf and NIKBUTavg, respectively). The meibomian gland loss of the lower eyelid was quantified using meibography and the meiboscale. Results: There was no significant difference regarding age or sex ratio between the two groups. The meiboscale in the MGD group was significantly higher than that in the non-MGD group (P ¼ 0.003). The non-MGD patients were more symptomatic than those in the MGD group (P ¼ 0.043). There were no significant differences between MGD and non-MGD groups regarding a Schirmer test (P ¼ 0.195), BUT (P ¼ 0.719), NIKBUTf (P ¼ 0.96), or NIKBUTavg (P ¼ 0.70). In the whole population, there was a negative correlation between meiboscale and NIKBUT (r ¼ À0.21, P ¼ 0.02), but no other correlations were found. Conclusions: Meibomian gland dysfunction was observed among different OSDs. Meibomian gland loss evaluated by meibography might help identify MGD in patients suffering from OSD. Translation Relevance: Meibography provides a better understanding of MGD in several OSD. It may be useful to integrate this objective analysis to improve treatments of OSD associated to MGD.

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Section: Discussionmentioning

confidence: 99%

The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases

Robin

Liang

Rabut

et al. 2019

Trans. Vis. Sci. Tech.

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“…3 SS is a chronic, inflammatory autoimmune disease that affects numerous exocrine glands, in particular the lacrimal gland, and is classified as primary or secondary. 5,6,9,10 Primary SS occurs as an independent disease without concurrent autoimmune rheumatic disease while secondary SS is associated with another rheumatic disease such as rheumatoid arthritis or scleroderma. 6 This case study focused on aqueous deficient dry eye, specifically related to secondary Sjogren's syndrome as the patient concurrently had a diagnosis of scleroderma.…”

Section: Discussionmentioning

confidence: 99%

“…3 In particular, SS dry eye, which had traditionally been categorized as strictly aqueous-deficient DES, may have an evaporative component due to associated meibomian gland dysfunction (MGD). [3][4][5] Therefore, clinical management of KCS caused by SS, a chronic inflammatory autoimmune disease, can be challenging. Roughly 40% of SS occurs in isolation and is considered primary SS, while approximately 60% occurs concurrently with another rheumatic disease and is considered secondary SS.…”

Section: Introductionmentioning

confidence: 99%

Alternative Therapies for Treatment of Keratoconjunctivitis Sicca Associated with Sjorgren's Syndrome

Brady

Man

2020

OCP

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Background: Sjogren’s syndrome is a chronic, systemic autoimmune disorder, which often results in significant ocular surface disease. Dry eye associated with Sjogren’s syndrome is a multifactorial disease which leads to decreased function of the lacrimal glands and altered tear composition. There currently are numerous anti-inflammatory methods used for treatment of this disease. Case Report: This case report will focus on the use of amniotic membrane placement and autologous serum tears to facilitate a successful scleral contact lens fit allowing for reduced ocular inflammation and discomfort associated with Keratoconjunctivitis sicca due to Sjogren’s syndrome. Conclusion: Clinical management of keratoconjunctivitis sicca due to Sjogren’s syndrome can be challenging. Diagnosis often requires numerous in office testing including Schirmer I/II, TBUT, sodium fluorescein stain, and osmolarity. Such testing can be repeated over time to monitor for improvement with addition of each new therapy. Various treatment modalities such as topical lubricants, cyclosporine, autologous serum tears, or amniotic membranes have been proven to provide short-term benefits and excellent maintenance of symptoms. Utilizing such treatments to promote an ideal scleral contact lens fit provides lasting benefits of corneal clarity and stable vision.

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“…20,21 For dry eye in SS, autoimmune abnormality-associated inflammation in the LGs, MG dysfunction, and goblet cell loss are reported in human patients and model animals. [22][23][24][25][26][27] SS model mice have inflammation in the HG. 28 In Japan, SS is diagnosed in patients exhibiting more than two of the following characteristics: lymphocyte infiltration in labial salivary glands or LGs; hyposecretion of saliva; hyposecretion of tear fluid or an injured cornea; and anti-Ro/SS-A and anti-La/SS-B antibodies in the serum.…”

Section: Introductionmentioning

confidence: 99%

Histopathological changes in tear-secreting tissues and cornea in a mouse model of autoimmune disease

Hiraishi

Masum

Namba

et al. 2020

Exp Biol Med (Maywood)

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The tear film covers the cornea, and its abnormalities (including immunological) induce dry eye. Using autoimmune disease model mice, BXSB/MpJ- Yaa (BXSB-Yaa), histopathological changes in the eye and tear-secreting tissues were examined using histopathology, immunohistochemistry, and electron microscopy at 8, 20, and 28 weeks for early, middle, and late disease stages. Early and middle stage BXSB-Yaa showed increased serum autoantibody and spleen weight-to-body weight (S/B) ratio, respectively, and higher tear volume than controls, BXSB/MpJ (BXSB), at early stages, which decreased with ageing and negatively correlated with autoimmune disease indices. Smaller Meibomian gland acini, intraorbital lacrimal glands, and Harderian gland acinar cells were seen in late stage BXSB-Yaa than in BXSB; the latter two indices decreased with ageing and negatively correlated with the S/B ratio. Cell infiltration occurred in the middle stage BXSB-Yaa extraorbital lacrimal gland, and acinar cells were smaller than BXSB. The conjunctival goblet cells decreased from early to middle stages in both strains, but in BXSB-Yaa, they increased at late stages with a partial lack of microvilli on the cornea and were inversely altered with anterior epithelium thickness through ageing, suggesting that they compensated for anterior epithelium damage. In conclusion, the tear film was unstable due to an autoimmune disease condition in BXSB-Yaa. Impact statement Cornea, an outermost layer of mammalian eye, is protected by tear film and abnormalities of tear film causes dry eye. Dry eye injures the cornea which results lower vision in patients. Several factors cause dry eye, including altered systemic conditions, environment, and immunological abnormality of the patient in autoimmune disease like Sjögren’s syndrome (SS). However, the detailed pathology of autoimmune abnormality-mediated dry eye is unclear. Here we demonstrated that systemic autoimmune abnormality in BXSB-Yaa mice was associated with histological changes in the exocrine glands and cornea of the eyes. We also showed that BXSB-Yaa mice developed mild or early stage dry eye-like disease and explain the existence of a compensatory mechanism associated with the dysfunction of these tissues. Thus, BXSB-Yaa could be a model for SS-like disease-associated dry eye and these data would contribute to the understanding of the pathogenesis of autoimmune-related dry eye disease.

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Meibomian Gland Dysfunction in Primary and Secondary Sjögren Syndrome

Cited by 54 publications

References 80 publications

The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases

The Role of Meibography in the Diagnosis of Meibomian Gland Dysfunction in Ocular Surface Diseases

Alternative Therapies for Treatment of Keratoconjunctivitis Sicca Associated with Sjorgren's Syndrome

Histopathological changes in tear-secreting tissues and cornea in a mouse model of autoimmune disease

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